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雅轩0310
Decompressive laparotomy has been shown to effec-tively reduce IAP and reverse the symptoms typicallyassociated with ACS [32]. In patients with severe acutepancreatitis and IAH, intra-abdominal fluid collectionsmay not always be present and therefore decompres-sive laparotomy and temporary abdominal closure isthe most effective way of decreasing IAP [7, 15, 33].The most common approach to decompressivelaparotomy is through a long, vertical midline incision,but a transverse incision to anticipate later pancreaticsurgery may also be used. Because of the risk of
爱做美梦的鱼
CASE 1: A Young Boy With Progressive Muscular and Pseudohypertrophy of CalvesCLINICAL DATAThis 5-year-old boy was the product of a normal pregnancy and delivery. He began to walk at the age of 15 months but has never be a able to run. By the age of 3, he had difficulty climbing steps and fell frequently. In order to get up from the floor, he would assist himself by putting his hands on his knees. There was no family history of any neuromuscular disease.On examination,he was found to have weakness of his shoulders, pelvic muscles and legs. His gait was unsteady and he could not hop on one foot. There was a mild lumbar lordosis .His deep tendon reflexes were decreased and he had minimal contracture of the Achilles tendons. There was considerable pseudohypertrophy of the calves. no myotonia could be elicited. Sensory examination was within normal limits.Electromyography was suggestive of myopathy. laboratory studies revealed a serum creatine phosphokinase(CPK) of 1600IU/l.A biopsy of the quadriceps femoris was performed to confirm the clinical diagnosis.QUESTIONS1. The most likely clinical diagnosis is A. Duchenne muscular dystrophy B. Limb-girdle muscular dystrophy C.myotonic dystrophy D. facioscapulohumenal muscular dystrophy2. The pattern of inheritance in Duchenne muscular dystrophy is A. autosomal dominant B. autosomal recessive C. x-linked recessive D. variable3. Good muscular biospy technique includes A. selection of a moderately affected muscle B. avoidance of sites previous injections,surgical incisions and punctures by EMG needles C.share dissection and use of an isometric clamp D. all of the above4. Patients with Duchenne muscular dystrophy usually die during the second or third decades from A. myositis B. pulmonary disease C. cardiac involvement D. malignancies5. If this child's disease fails to progress, if he remains ambulatory past the age of 10 or 12 and if no electrocardiographic abnormalities appear, one would have to revise the diagnosis to A. limb-girdle muscular dystrophy B. myotonic dystrophy C. Becker muscular dystrophy D. none of these6. Younger male siblings with no overt clinical abnormalities may show A. histological evidence of active muscular dystrophy B. elevated serum muscle enzymes C. histological evidence of an abortive form of muscular dystrophy D. none of above7. which of the following are useful in determining whether the mother and any of her daughters are carriers? A. Muscular boipsy B. Serum muscle enzymes C. Electromyography D. All of these
